SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In a prospective study of 26 premature infants, 5 microliters microdrops were compared with standard 26 microliters eye drops of cyclopentolate 0.5% and phenylephrine 2.5%. There was no statistical difference in pupil dilatation. The 5 microliters microdrops have potentially fewer adverse effects in premature infants.
During routine dilation of 48 newborns, systemic responses and pupil dilation were monitored. Both 10 percent aqueous and viscous phenylephrine caused blanching around the eyes and produced considerable rise in blood pressure. Dilatation average 4.7 mm. In a double blind study, a 2.5 percent solution caused no skin blanching and no change in pressure or heart rate. Average dilation was 4.5 mm. No blood pressure changes were observed with either one percent cyclopentolate or one percent tropicamide. Average dilatations were 5.0 mm and 5.3 mm respectively. The above agents, used individually for a total dosage of three drops in each eye did not provide adequate dilation for a thorough funduscopic examination. Our protocol at United Hospitals Medical Center is a safe combination of drugs and provides excellent dilatation averaging greater th an 7 mm. No skin blanching or change in heart rate was observed.
Retinoscopy under cycloplegia using cyclopentolate (Cyclogyl) hydrochloride was performed on 18 patients (36 eyes) with partial or complete accommodative esodeviation, during and after treatment with echothiophate (Phospholine) iodide. Measurements were clinically comparable on both occasions, regardless of concentration of echothiophate, duration of administration, or interval from discontinuance until refraction. It appears to be unnecessary to discontinue echothiophate iodide in order to obtain reliable cycloplegic retinoscopic measurements.
Administration of mydriatic medication and ophthalmologic examination have previously been associated with feeding intolerance, characterized by large retained gastric aspirates and abdominal distention. In an attempt to eliminate this problem, we instituted a policy of withholding feedings for four hours following ophthalmologic examination. A prospective series of 50 consecutive patients was then followed to determine the incidence of feeding intolerance 24 hours prior to and 24 hours following the examination. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride prior to the examination. A critical review of the nursing notes revealed no increased incidence in feeding intolerance during the 24-hour period following examination. There were no cases of necrotizing enterocolitis during either period. This study provides evidence that the incidence of feeding intolerance following ophthalmologic examinations might be reduced by withholding feeding for four hours after the examinations.
Eye drops used for diagnostic mydriasis may produce systemic side effects in preterm infants. Studies on the pupil dilating and systemic effect of various mydriatic agents yielded conflicting results. We conducted a prospective randomized double-blind study on the systemic effect of two mydriatic eye-drop combinations. Thirty-nine preterm infants were randomly assigned to two groups. An eye-drop combination of 2.5% phenylephrine and 0.5% tropicamide (group D) was compared with the combination of 0.5% cyclopentolate and 0.5% tropicamide (group F). Either eye-drop combination was followed by 0.5% tropicamide given 20 minutes later. Heart rate (HR) and the systolic, mean, and diastolic blood pressure (BP) were recorded before and after eye-drop instillation and after ophthalmoscopy. A control session with NaCl eye drops was added for each infant. A significant increase of BP and HR peak values was observed within 7 to 10 minutes after the cyclopentolate/tropicamide combination only. On the other hand, the mydriatic effect of the phenylephrine/tropicamide combination was significantly superior to that of the cyclopentolate/tropicamide combination. We recommend the combination of 2.5% phenylephrine and 0.5% tropicamide to achieve a sufficient diagnostic mydriasis without systemic side effects in preterm infants.
A patient suffering from open angle glaucoma was treated with topical phospholine iodide and epinephrine. Before treatment the anterior chamber was deep and the angle wide open in both eyes. Two weeks after beginning treatment there was an acute elevation of pressure to 52 mm hg in the right eye accompanied by myopia, shallowing of the anterior chamber and closure of the angle. These findings were dramatically reversed by the instillation of one drop of tropicamide and one drop of cyclopentolate. Simultaneous contraction of the dilator and sphincter muscles of the iris in this case probably caused pupillary block and closure of the anterior chamber angle, in spite of the initially wide open angle. Phospholine iodide may also have caused a spasm of the ciliary muscle and a forward movement of the lens, in a manner similar to that thought to occur in malignant glaucoma. Strong miotics together with epinephrine should be used cautiously in the treatment of glaucoma even when the initial examination shows a wide open angle.
Hong Kong Chinese infants were refracted by retinoscopy at regular intervals between the age of approximately 10 and 40 weeks. Cyclopentolate 1% was used to obtain cycloplegia. The spherical equivalent of the refractive error was calculated for each child and analysis of variance carried out according to the refractive status of the parents. From approximately 20 weeks of age a significant difference was found between the mean spherical equivalent of the refractive error of infants of parents both of whom were myopic and that of infants of parents neither of whom was myopic. At 40 weeks of age a good fit with an autosomal recessive probability model was obtained.
We have studied 21 eyes of 17 patients which underwent 3 Months before a standard extracapsular cataract extraction and implantation into the sulcus of a posterior chamber lens. All the eyes had a final uncorrected far and near vision of 0.4 (20/50) or better. We have measured the uncorrected near vision before and after pupillary dilatation with 5% phenylephrine. Then, after additional 0.5% cyclopentolate induced cyclopegia, near vision was evaluated again. Our results show a statistically significant decrease in the uncorrected near vision after pupillary dilatation (p less than 0.001). On the contrary additional cyclopegia does not significantly reduce the uncorrected near vision (p greater than 0.08). Our observations confirm the importance of unimpaired pupillary movement as regards best possible uncorrected near vision in pseudophakic patients. The activity of the ciliary muscle does not seem to mainly contribute to the phenomenon of pseudoaccommodation.
The relationship between accommodative fluctuations and perimetric sensitivity was investigated in a group of 10 clinically normal emmetropic subjects using the Dicon AP3000 computer-assisted perimeter at a bowl luminance of 10 asb. Accommodative microfluctuations were attenuated with the antimuscarinic drug cyclopentolate HCl 1% and the concomitant mydriasis was matched on a separate trial using the sympathomimetic phenylephrine HCl 10%. Saline 0.9% was used as the control. Accommodative microfluctuations were found to play a minor role in determining the magnitude of sensitivity out to an eccentricity of 5 degrees; between 5 degrees and 27.5 degrees, the effect of microfluctuations was masked by the mydriasis produced by the drugs used in the study. The range of sensitivity values at a given location were reduced when accommodative fluctuations were minimized.
The mydriatic effect produced by ointment preparations of cyclopentolate 1%, tropicamide 1%, and phenylephrine hydrochloride 10% was compared to the mydriasis elicited by the aqueous solutions of the same concentrations of drugs in children and adults. There was no difference in the amount of mydriasis produced by one instillation of a very small volume of the drug in ointment in one eye when compared to multiple instillations of the aqueous solution of the same drug in the contralateral eye in 30 minutes. There were no complaints of ocular irritation when the ointment preparations were instilled into the eye; however, there were frequent complaints with the use of these drugs in aqueous solutions.
We compared the depth of the anterior chamber and the optimal distance refraction in a group of patients with soft and rigid intraocular implants under pilocarpine (maximal ciliary contraction) and cyclopentolate (maximal ciliary relaxation) in order to determine if lens movement might account for the apparent accommodation phenomenon. Lens shifts ranging from 1.5 to 0.02 mm and refractive variations up to 1 D were found. However, the discrepancies between amount of shift and refractive variations suggest that lens movement does not play a relevant role in this phenomenon.
Cyclopentolate refractions of 146 premature infants disclosed higher incidences of myopia and anisometropia than those reported for full-term infants. Also, more than 70% of the premature infants had I diopter or more of astigmatism; 83% of the astigmatism was against-the-rule. Infants with shorter gestational periods had more severe myopia and astigmatism. Infants born very prematurely should undergo follow-up refractions to determine whether they retain refractive errors large enough to interfere with visual function.
Sustained pupillary dilation during cataract surgery may be achieved with preoperative noncorticosteroidal anti-inflammatory agents such as flurbiprofen. However, these agents may interfere with miosis after injection of acetylcholine. Thirty patients for extracapsular cataract extraction were randomly assigned in a double-masked fashion to receive either a placebo or preoperative 0.03% flurbiprofen every 30 minutes for four doses. All patients also received three doses of 2.5% phenylephrine and 2% cyclopentolate. Pupillary diameter was measured the day before surgery, immediately before the surgical incision, immediately before and five minutes after acetylcholine injection, and the morning after surgery. The flurbiprofen group had a larger mean pupillary diameter before injection of acetylcholine (P less than .001), five minutes after acetylcholine (P less than .001), and on the first postoperative day (P less than .005).
The relation of astigmatism and myopia was analyzed in 298 myopic children, ages birth to 10 years. The mean spherical equivalent, determined by cyclopentolate retinoscopy, for the entire group was--2.9 diopters and did not change significantly with age. However, in 3-year-old children and younger, myopia progressed in eyes with greater than or equal to 1 diopter of cylinder and tended to increase through age 8 years in those having greater than or equal to 3 diopters of cylinder. Also, astigmatic errors greater than or equal to 1 diopter, especially of oblique orientation, were associated with higher degrees of myopia than nonastigmatic errors. These data from myopic children suggest that uncorrected astigmatism during a period of visual immaturity influences the course of myopia. Thus, naturally occurring astigmatic errors, that are frequent among infants and young children, appear to have a role similar to the vision blurring perturbations that trigger the development of myopia in young animals. Ascertainment and full correction of these refractive errors in young children may be important in assuring the best possible vision.
The author conducted a six-group, randomized, clinical trial to compare the relative efficacies of use of preoperative topical Ocufen (flurbiprofen), or Indocid (indomethacin, Indocin), with and without concurrent intraoperative epinephrine treatment; epinephrine treatment alone; and placebo in maintaining surgical mydriasis produced by preoperative administration of phenylephrine and cyclopentolate before cataract intraocular lens (IOL) surgery. Two hundred sixteen cases were randomized to receive one of the six treatment combinations. The treatment groups not receiving epinephrine (placebo, Indocid, Ocufen) had average percent decreases in pupil diameter of 19 to 24%, whereas groups receiving epinephrine (with or without Ocufen or Indocid), had decreases of only 0.8 to 2.6%. The effect of epinephrine treatment was significant (P less than 0.0001), regardless of nonsteroidal anti-inflammatory drug (NSAID) treatment. Indocin patients (without epinephrine) had less miosis than placebo patients; the proportion of cases with large decreases in pupil diameter (greater than or equal to 2 mm) was reduced by approximately 50%. Ocufen had an additive effect with epinephrine; the group with Ocufen + epinephrine treatment had a smaller proportion of cases with pupil size decreases than the group with epinephrine alone.
Pretreatment with topical nonsteroidal anti-inflammatory drugs is common practice to maintain maximal pupil dilation for cataract surgery. Most surgeons also inject a cholinergic agent intracamerally for miosis after intraocular lens insertion. We evaluated the effects of topical suprofen and flurbiprofen on the miosis induced by anterior chamber irrigation with either acetylcholine or carbachol. One eye of 30 pigmented rabbits was dilated with cyclopentolate HCl and phenylephrine HCl. Three groups, each composed of ten eyes, received flurbiprofen, suprofen, or a control. In each group, five eyes received acetylcholine by anterior chamber irrigation and five received carbachol. Pupil diameters were measured with calipers before and five minutes after irrigation by an observer unaware of the treatment regimen. Irides irrigated with carbachol constricted less than those irrigated with acetylcholine (P = .016). In anterior chambers irrigated with carbachol, suprofen was associated with less miosis than either tears (P = .005) or flurbiprofen (P = .009); however, if the infusion was performed with acetylcholine, no differences between the three groups were noted (P = .44).
Flurbiprofen (Ocufen), an antiprostaglandin, has been introduced into cataract surgery. It is used to prevent intraoperative miosis by blocking inflammatory mediator formation. Ocufen has been noted to diminish the controlled miosis produced by using acetylcholine in the operative period. This study evaluated the pupillary response to acetylcholine after it had been exposed to Ocufen. This was done using a control versus a study eye in 16 rabbits dilated with phenylephrine hydrochloride and cyclopentolate hydrochloride. The pupil diameters were measured at baseline, then the rabbits' anterior chambers were irrigated with an acetylcholine solution. The resultant pupillary diameters were measured at one and five minutes. At five minutes post-irrigation there was a statistically significant greater constriction in the control group than in the Ocufen group. This implies that Ocufen dampens the iris musculature's response to acetylcholine.
This study compared refractive error obtained by the "near retinoscopy" method as described by Mohindra and static retinoscopy under cycloplegic conditions. Twenty-two patients between the age of 3.6 and 10.0 years were objectively refracted. The examiner performed a near retinoscopy on each patient. Immediately after this procedure, 2 drops of 1% Cyclogyl (cyclopentolate) were administered to each eye, 5 min apart. Cycloplegic retinoscopy was performed 35 to 40 min after the 2nd drop was administered. In order to reduce examiner bias, the specific powers of the neutralizing lenses were unknown to the examiner throughout the entire procedure. On average, retinoscopy under cycloplegic conditions revealed +0.50 to +0.75 D more plus than near retinoscopy. Although the Student's t-test indicated the values were significantly different on an absolute basis, a Pearson's r of +0.85 was found when all meridians were compared. In addition, if a "cut" factor is introduced to adjust for normal accommodative tonus eliminated under cycloplegic conditions, the two procedures produce essentially the same results.